Nussbaum ES. Video Atlas of Intracranial Aneurysm Surgery. Thieme; 2012; 160 pgs; 247 illustrations; $89.99
In his text Video Atlas of Intracranial Aneurysm Treatment, Eric S. Nussbaum assembles the knowledge gained from one of the larger open surgical experiences among modern cerebrovascular neurosurgeons, in an incredibly concise, technique-heavy 129 pages, and in several hours’ worth of operative video. He demonstrates the performance of the gamut of surgical techniques used in the treatment of intracranial aneurysms, but cones down upon the more common aneurysm types and locations. The target audience for this text is limited primarily to relatively inexperienced neurosurgeons, and excludes all but the most curious of neuroradiologists.
Instead, it is ideally suited for three groups of readers: junior-level neurosurgical trainees in high-volume open aneurysm centers, as preparation for what they will do in the coming years; senior-level neurosurgical trainees in lower-volume open aneurysm centers, as an adjunct to the cases that they perform; and junior cerebrovascular neurosurgeons in practice, as a refresher when preparing for cases. The text is concise and to-the-point, and its content chock-full of surgical techniques and pearls. Chapters are dedicated to aneurysms of specific locations, eg, MCA, supraclinoid ICA, basilar artery, etc; each chapter includes an exceptionally useful table of pearls and pitfalls, and any neurosurgeon who has treated intracranial aneurysms can attest to the wisdom in these. Any neurosurgical trainee would do well to commit each of these tables to memory. The artist depiction-photograph overlay figures are truly excellent—Rhoton preaches see-through 3-dimensional anatomic understanding, and these figures serve to address exactly that.
Competing texts exist that specifically address the more common aneurysms, including that of Yasargil, who is generally considered the father of microscopic neurosurgery. More recently, Samson and Lawton have published separate books detailing their extensive experiences in the treatment of intracranial aneurysms. Samson’s book is conversational in tone, and is packed tightly with lessons learned over decades of experience. Lawton’s book is extremely well-organized and comprehensively teaches the surgical technique of aneurysm surgery—his work should be a required compendium to operative training.
Yet, these publications lack the most fundamental aspect of technique training, which is the most invaluable aspect of Nussbaum’s contribution: allowing the reader to see the surgery unfold. The most comprehensive video atlas of its kind, there are few competing sources containing similar material (a small collection of teaching videos exists on the AANS website). The videos are smartly cut, and the selected cases leave the viewer with the feeling of having just finished his/her chief residency. At least 95% of the aneurysms the practicing cerebrovascular neurosurgeon will encounter are covered in these videos, and each brings to the table certain considerations particular to such a case.
The narrative is exactly that—a narration of the activity seen on the screen, and, unfortunately, does not adequately reveal the considerations that should be swimming through the mind of the surgeon (eg, proximal control, instrument angulation, counter-tension, etc.). Though these points are likely rote to a surgeon of the author’s experience, in order for the trainee to learn more thoroughly from these videos, such points must be voiced specifically. The low quality of the standard definition videos and editing of the arachnoid dissection portion from most cases prevents this publication from more effectively reproducing operative experience. However, the wealth of material included makes this text worthy of study for any trainee interested in learning cerebrovascular neurosurgery.
Editorial errors are few and are of little interest to the readership of this review. The text is succinct and high in quality, sacrificing a few specific topics that limit its applicable audience, relative to other books addressing this topic. As Nussbaum notes in his text, exposure, particularly the arachnoid dissection, represents the bulk of the operation, and that the actual clip placement often feels anticlimactic. Learning and practicing the techniques necessary for a clean and precise exposure are the hallmark of excellent training; unfortunately, this work fails to dedicate to them the attention that they deserve. True, techniques employed in Sylvian fissure dissection vary, but Nussbaum clearly has a well-practiced and efficient method, and likely has the expertise to teach many other strategies as well. This book ideally would have included a video and textual chapter dedicated to cranial exposure (ie, how to flatten the sphenoid wing), and arachnoid dissection, and also might have expounded upon CSF access (ie, suprachiasmatic cistern access and drain placement), and stroke-prevention strategies for atheromatous and calcified aneurysms more robustly.
With approximately 2,000 intracranial aneurysms treated using the entire breadth of surgical and medical technique, as well as the direct tutelage of Drake, Nussbaum’s text is invaluable, its format is absolutely essential, and it will undoubtedly encourage even more technically comprehensive, visually descriptive contributions to the educational literature regarding the surgical management of intracranial aneurysms.
